Balance, Agility, and Dual-Task Training for PD: Benefits and Prescription Based on Research

Individuals with Parkinson’s Disease have impaired automaticity of movement meaning their movements become less automatic and they have to think more about what they are doing in order to compensate (more on this in future blog posts!). Because of this, it becomes more challenging to do two things at once such as walking while talking or thinking about something else. This has been shown to significantly increase someone’s risk for falls. The loss of automatic movements leads to an increase in dual task cost. This means it takes more brain power to do two things at once. For these reasons, it is important to incorporate a cognitive challenge with exercise in order to help reduce the dual task cost and reduce risk for falls. In this blog post we will discuss some of the research involving balance, agility and multi-task training.

What is Balance, Agility, and Dual-Task Training?

This type of exercise involves activities such as multi-directional stepping, weight shifting, large amplitude movements, floor exercises such as PWR! moves, balance on different surfaces such as foam, and doing multiple things at once such as waking or stepping while performing a cognitive task at the same time. There are many benefits to doing this type of training such as:

• Improved balance

• Improved sensory integration

• Reduced fall risk

• Improved quality of life

• Improved cognition

What does the research say?

A research study by Jung et al (2020) examined the effects of an agility boot camp with cognitive challenge exercise program for people with Parkinson’s Disease. 86 individuals with PD were included in this study and they were randomized to a control group that completed an educational intervention and an experimental group that completed 6 weeks of the agility boot camp with cognitive challenge (ABC-C) program. The program consisted of gait (walking) training, PWR! Moves, agility course, lunges, boxing, and tai chi with cognitive challenges built in throughout. They found that the individuals that participated in the boot camp had an improvement in their balance, a reduction in dual task cost, and improved activities of daily living and quality of life especially in those with more advanced PD.

This graph shows the improvement in dual task cost following the agility boot camp with cognitive challenge exercise program. You can see how there was no significant change after receiving education, but with the exercise intervention there were significant improvements in dual task cost (as seen in red).

Another study by King et al (2020) examined the effects of the same agility boot camp with cognitive challenge program on freezing of gait in people with Parkinson’s Disease. This study included 46 individuals with Parkinson’s Disease and they were randomized to a control group that completed an educational intervention and an experimental group that completed 6 weeks of the agility boot camp. They found that individuals that completed the agility boot camp had a reduction in freezing of gait, improvements in balance and cognition, a reduction in dual task cost on gait speed, and improvements in connectivity in the brain measured via functional MRI. 

Balance Systems and Parkinson’s Research:

There are three systems that help us to control our balance. First, is our vision. Most people are heavily reliant on vision for balance meaning they use vision to help orient themselves and maintain equilibrium. Next is our somatosensory input. This is our ability to feel and interpret sensory information that is sent up through our feet to help us maintain our balance. The third system is the vestibular system. This is an inner ear equilibrium system that helps us detect motion, head position and orientation in space. In Parkinson’s Disease, individuals have difficulty with integrating information from these three systems which contributes to poor balance and high risk for falls. Research by Fil-Balkan et al (2018) examined the effects of sensorimotor integration training (training these three balance systems) in people with Parkinson’s Disease. They found that after completing physical therapy two times per week for six weeks, individuals that worked on sensorimotor integration training had a significant improvement in their balance. This demonstrates that it is important to train all three of these balance systems to work together and reinforces why it is important to practice balancing on various surfaces that are uneven (such as ramps) and compliant (such as foam pads) while altering the visual conditions such as with head turns or with eyes closed.

Exercise Prescription:

Now that we know the benefits of performing balance and agility exercises with a cognitive challenge, let’s discuss how to implement this type of exercise. It is recommended to do this type of exercise 2-3x per week (or daily if you can!) for a total of 2-3 hours per week. There are many different ways to implement this type of exercise. One of our favorite ways is through performing PWR! Moves or other agility based movements with an added cognitive challenge that is performed at the same time. There are so many ways to add a cognitive challenge to your exercises. Some examples of ways to add a cognitive challenge include:

• Naming a word, animal, or food that starts with each letter of the alphabet

• Naming as many items as you can think of from certain categories (cities in California, sports, farm animals etc)

• Naming as many items as you can think of that are a certain color

• Performing certain exercises in a sequence that you need to recall such as doing a PWR! Flow

We hope you have found this blog post helpful. Please consult with your physician or physical therapist if you are interested in starting a new exercise program and don’t hesitate to reach out to us if you have any questions! We hope to see you in an exercise class soon!

Sources:

Jung et al, 2020. Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson’s disease. Npj Parkinson’s Disease 6(31). 

King et al, 2020. Cognitively challenging agility boot camp program for freezing of gait in Parkinson’s disease. Neurorehabil Neural Repair 34(5): 417-427. 

Fil-Balkan et al, 2018. Sensorimotor integration training in Parkinson’s disease. Neurosciences 23(3).